Co-management; doctors and users pulling together

Doctors and patients represent the two fundamental cornerstones of any health care model, and there is much more that unites them than divides them. Health care management shared by professionals and users is possible, and beneficial for both parties. As demonstrated by the co-management model developed by the Spanish health co-operatives Autogestió Sanitària and SCIAS, which has been operating successfully for 40 years now.

This was one of Dr Josep Espriu’s convictions: the two central figures in the health care system are doctor and patient. On the basis of this certainty, he devised a new health care management model in which both professionals and users would have the same influence and degree of participation in key decisions. And to this end he launched a co-operative movement which consolidated its position in the 1970s, reaching its culmination in 1989 with the opening of Barcelona Hospital, which belongs to the Assistència Group.


The Assistència Group includes various entities, but is essentially based on two co-operative enterprises: Autogestió Sanitària, which groups together some 5,000 doctors, and Societat Cooperativa d’Instal.lacions Assistencials Sanitàries (SCIAS), comprising 166,000 users. And while Autogestió Sanitària, the doctors’ co-operative holds most of the shares in the insurance company, Assistència Sanitària Col.legial (ASC), the SCIAS users’ co-operative owns the Barcelona Hospital facility.

The insurer ASC is governed by a Board of Directors, while the SCIAS co-operative has its own Governing Board, although leading members of both boards meet every Wednesday afternoon for the Group Commission to agree the most important decisions together.

How health care co-management works?
All the fundamental management decisions about the hospital are referred to this joint commission of doctors and users. Once the decisions have been taken, the ASC directors present them to their Board of Directors, while the SCIAS directors put them before the Governing Board for them to be approved and formalised.

All strategic needs are agreed at the weekly meetings; the functioning of a new installation, the price of the premium paid by the insureds each month, the price of the annual increase in medical fees, the amount of money to be invested each year…

One of the main advantages of the co-management model characterising the Assistència Group, compared with other both public and private approaches is that there are no political or social or financial intermediaries, which means the decisions are taken very directly by those involved in the system: the professionals, the doctors, on the one hand, and the potential patients, or citizens, on the other. Within this model, major organisational, conceptual and steering decisions are taken directly by those involved in the system. The professionals work freely, and users can choose the professional they want to care for them within the system. We do not depend on any prevailing political approach or social trend. The purpose of the co-operatives involved is not for profit, but for service.

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